BJ Bartleson provides leadership in developing, communicating and
implementing CHA policy related to nursing, emergency services,
trauma and medication safety. She is recognized statewide and
nationally as a nurse leader with more than 30 years of
experience as an administrator, educator, researcher, clinician,
manager and expert in multiple areas of acute patient care
management and nursing practice.

BJ received her bachelor of science degree with distinction at
the University of Virginia School of Nursing in 1978, and her
master’s degree in nursing administration at the University of
California, San Francisco, in 1990. She served as the 2010
Association of California Nurse Leaders president and was on the
board of the American Organization of Nurse Executives for more
than 10 years. She has also served on the CHA Board of Trustees
and the American Hospital Association Regional Policy Board.

The California Department of Public Health will hold a meeting
Sept. 10 at 2 p.m. (PT) to gather stakeholder suggestions for
updating hospital regulations related to radiology and
interventional radiology service. Details for attending the
meeting in person or via WebEx are available in All Facilities
Letter 19-29; a
discussion guide for the meeting is also available.

Based on findings from a survey and focus groups of educators,
nurses, and employers, a
newly released report offers evidence-based recommendations
to help educational institutions prepare registered nurses for
the future of primary care.

The Emergency Medical Services Authority (EMSA) has proposed
changes to regulations governing the standards, policies, and
procedures for paramedic training, scope of practice, licensure,
and discipline. The
modified text, as well as the Notice of Proposed Regulations,
Initial Statement of Reasons, and other regulatory documents are
available for review on EMSA’s website.

In All
Facilities Letter (AFL) 19-28, the California Department of
Public Health has announced a nationwide shortage of the
tuberculin skin test antigen Aplisol, as well as new guidelines
from the Centers for Disease Control and Prevention (CDC) for
tuberculosis screening of health care personnel. The notice also
reminds providers that an approved program flexibility is
required if a facility deviates from tuberculosis screening
requirements.

The Substances Abuse and Mental Health Services Administration
(SAMHSA) has released a series of fact sheets for the families of
first responders, intended to help them understand and cope with
the potential mental health issues that emergency personnel may
face, and to help children understand their parents’ role at
work.

The California Health Alert Network (CAHAN)
reports that, since June, seven cases of severe acute
pulmonary disease requiring hospitalization and respiratory
support among adults who have been vaping cannabis or cannabidiol
oils have been reported to the Kings County Health Officer.
Clinicians who encounter similar cases should report them to
their local health department.

On July 18, the California Department of Public Health (CDPH)
released a California
Health Advisory Update on Ebola — one day after the World
Health Organization declared the Ebola outbreak in the Democratic
Republic of Congo to be a public health emergency of
international concern.

The California Society of Health-System Pharmacists (CSHP) will
host a webinar Aug.
1 to share updates about implementation of a new law — Senate
Bill 1254 (Chapter 697, Statutes of 2018) — that requires
hospitals to establish criteria for defining high-risk patients
and complete a medication profile for those patients.

On July 1, the California Department of Public Health and the
Emergency Medical Services Authority deactivated the Medical
and Health Coordination Center, which was activated in response
to the April 2019 measles outbreak. Local health jurisdictions
are no longer required to submit weekly situation reports and
cost tracking related to the outbreak. Instead, they should
follow the defined response protocols in the Public Health and
Medical Emergency Operations Manual.

Last month, the Food and Drug Administration (FDA)
cleared a modified Erbe USA Inc. ERBEFLO 24-hour
multi-patient endoscope connector for use. The modified port
connector now includes a backflow prevention feature designed to
help reduce the risk of cross-contamination that was
previously identified in a letter from the FDA in April 2018.

Questions should be directed to the FDA’s Division of Industry
and Consumer Education at DICE@FDA.HHS.GOV, (800) 638-2041 or
(301) 796-7100.

The California Department of Public Health’s Licensing and
Certification Program has issued a reminder to health care
facilities that, as the hot summer weather begins, they should
have contingency plans in place to deal with the potential loss
of air conditioning; ensure patients and residents are free of
adverse conditions that may cause heat-related complications; and
report extreme heat conditions that compromise patient health or
require evacuation, transfer, or discharge of patients. More
information and guidance are available in All
Facilities Letter 19-21.

The United States Pharmacopeia (USP) has released newly revised
standards to assist health care practitioners in
consistently producing high-quality compounded medicines that are
the right strength and free of contaminants. The final
USP
797, USP
825, and USP
795 and
General Chapter 800 standards will take effect Dec.
1.

Beginning July 1, the California Department of Public Health will
not accept payment for health facility license application fees
until its Licensing & Certification Centralized Applications
Branch validates that all required forms and supporting
documentation have been received. For more information, see
All
Facilities Letter 19-20.

Under
Senate Bill 1254 (Chapter 697, Statutes of 2018), hospitals
must establish criteria for high-risk patients and complete a
medication profile for those patients. To better understand
how this new requirement will impact patient safety, CHA and
California Health System Pharmacists members will undertake a
six-week, multi-center
quality improvement project.

The California Department of Public Health (CDPH) earlier this
week released All
Facilities Letter 19-19, which updates its application
process for new or remodeled pharmacy clean rooms and mobile
sterile compounding units (MSCUs). Notably, CDPH will no longer
accept incomplete applications for pharmacy clean rooms or MSCUs.
CDPH states the update is in response to Assembly Bill 2978
(Chapter 992, Statutes of 2018), which requires CDPH to review or
deny applications within 100 days of receipt.

New regulations from the Emergency Medical Services Agency
(EMSA) establish standardized best practices for emergency
medical services for children programs. CHA and member hospitals
worked closely with EMSA’s Emergency Medical Services for
Children Committee to produce regulations to provide quality care
for children needing emergency services, and is pleased to see
the regulation finalized. It will take effect July 1.

With 21 measles cases reported in California this year, the
California Department of Public Health has offered detailed
recommendations – through
All Facilities Letter 19-17 – for identifying and
addressing the disease. The cases reported so far have
resulted in hundreds of investigations of possible contact
as well as transmission of the disease in emergency departments
and other health care settings.

The Emergency Medical Services Agency (EMSA) has issued
proposed regulations that, when finalized, will allow
emergency medical services providers to transport patients to the
hospital or other care setting that best meets the patient’s
needs. The proposed regulations address paramedic training and
establish other requirements for alternative destination
protocols.

Influenza activity remains high across the United States,
according to a
health alert recently issued by the Centers for Disease
Control and Prevention (CDC). The CDC notes that the season is
likely to last several more weeks and continues to recommend
antiviral medications for influenza treatment, regardless of
whether a patient received the influenza vaccine.

A new
health advisory from the California Department of Public
Health (CDPH) reminds providers to be aware of potential measles
cases, as 16 cases have been reported in California since
Jan. 1. CDPH notes that providers should not rule out a measles
diagnosis based solely on patients reporting they previously
received a measles immunization.

In response to providers’
recent challenges implementing new requirements for opioid
prescriptions, the governor has signed into law a bill that
allows a transition period before the requirements become
effective.

The Drug Enforcement Administration has moved Epidiolex
from Schedule I to Schedule V. According to
All Facilities Letter 19-06, issued last week by the
California Department of Public Health, cannabis-derived drugs
that are approved by the Food and Drug Administration and that
have no more than 0.1 percent residual tetrahydrocannabinols will
be moved to Schedule V. Currently, only Epidiolex meets
those requirements. Drugs that do not meet these criteria may not
be prescribed or dispensed.

A
new report identifies the clinical capacity of and training
needs for the state’s nursing workforce, particularly RN
surpluses and shortages by region. The report is the culmination
of a landmark initiative to identify innovative solutions for the
most challenging nursing education issues facing California.

The Emergency Medical Services Authority (EMSA) has released
three sets of proposed regulations for a 15-day comment period.
The proposals are intended to establish standardized best
practices for their respective systems.

The Emergency Medical Services Authority (EMSA) is in the process
of updating its Statewide Trauma System Triage and Transfer
Resource Guide. The
draft guide incorporates feedback from a previous comment
period in 2017. Due to the time elapsed since then, EMSA has
offered another comment period.

Last week, CHA
shared information about problems some providers have had in
implementing a new state law requiring controlled substance
security prescription forms to include a unique serial number.
This week, the California Board of Pharmacy released updated
frequently asked questions about the law’s requirements and
enforcement.

As of Jan. 1, controlled substance security prescription forms
must include a new, unique serial number in a format approved by
the Department of Justice. However, the new requirement
does not allow for a transition period during which
providers would be allowed to use the previously approved form,
and those who do not have access to the new forms have been
forced to choose between denying care and risking action against
their licenses.

Prescribers are now required to offer naloxone hydrochloride, or
another drug approved by the Food and Drug Administration, to
patients who experience certain conditions related to opioid
depression. The Medical Board of California has
released frequently
asked questions to assist providers in implementing the new
requirements, which took effect Jan. 1.

CHA has submitted the attached comment letter to the Board of
Registered Nursing (BRN) in response to proposed changes to
regulations for advanced practice registered nurses (APRNs). The
proposal would modernize terminologies and
certification/accreditation requirements, conforming with current
practice.

CHA and the California Society of Health-System Pharmacists have
finalized a tool to assist pharmacy staff in complying with
sterile compounding regulations. Developed by CHA’s Medication Safety Committee,
the attached grids interpret U.S. Pharmacopeia (USP) 797 and
proposed USP 800 requirements, as well as California Board of
Pharmacy sterile compounding regulations. The grids also
detail requirements related to temperature and monitoring,
frequency of documentation and cleaning, facilities and
engineering controls for hazardous and non-hazardous drugs,
competency and training, and garbing. More resources can be found
in CHA’s Medication
Safety Toolkit.

The CHA Medication Safety Committee provides leadership within the hospital/health system and health care community to promote the highest standards of safe and effective use of medications. The committee is made up of a group of diverse multidisciplinary health care organizations who act as a source of medication safety expertise. The committee provides a venue for the coordination of medication safety activities.

Special resource toolkit developed by CHA’s EMS/Trauma
Committee and the Center for Behavioral Health. Designed to
help staff provide support to patients in the ED with psychosis
and/or substance abuse disorders, this toolkit provides
access to articles, policies, management techniques, assessment
tools and more. Click the topic tabs below to access resources
and information.

More and more, healthcare professionals and regulators are
turning their focus to mitigating risk for medication management
in the emergency department. Reducing opportunities for
medication error and increasing the opportunities for a safe
medication management environment represents a prime opportunity
to improve the healthcare delivery system – and helping your
organization do so is the goal of this tool.

CHA Vice President of Nursing and Clinical Services, BJ
Bartleson, has been appointed by the American Organization of
Nurse Executives (AONE) to serve on its International
Committee. During her one-year commitment, which starts
Jan. 1, 2013, she will be tasked with providing input on
international initiatives for AONE and finalizing the
international consortium (ICN) of nursing leadership associations
that will be explored at the 2013 ICN meeting.

Bartleson has been actively involved with AONE since
1990. A former AONE Board member, she most recently
served on the AONE Future Patient Care Delivery Committee and
Health Policy Committee where she helped develop key
transformational guidelines to enhance nursing practice for the
future.